Although neuropsychological studies of the amnesic patient H. M. provide compelling evidence that normal memory function depends on the medial temporal lobe, the full extent of his surgical resection has not been elucidated. We conducted magnetic resonance imaging studies to specify precisely the extent of his bilateral resection and to document any other brain abnormalities. The MRI studies indicated that the lesion was bilaterally symmetrical and included the medial temporal polar cortex, most of the amygdaloid complex, most or all of the entorhinal cortex, and approximately half of the rostrocaudal extent of the intraventricular portion of the hippocampal formation (dentate gyrus, hippocampus, and subicular complex). The collateral sulcus was visible throughout much of the temporal lobe, indicating that portions of the ventral perirhinal cortex, located on the banks of the sulcus, were spared; the parahippocampal cortex (areas TF and TH) was largely intact. The rostrocaudal extent of the ablation was ϳ5.4 cm (left) and 5.1 cm (right). The caudal 2 cm, approximately, of the hippocampus body (normal length, ϳ4 cm) was intact, although atrophic. The temporal stem was intact. Outside the temporal lobes, the cerebellum demonstrated marked atrophy, and the mammillary nuclei were shrunken. The lateral temporal, frontal, parietal, and occipital lobe cortices appeared normal for age 66 years. The mediodorsal thalamic nuclei showed no obvious radiological changes. These findings reinforce the view that lesions of the hippocampal formation and adjacent cortical structures can produce global and enduring amnesia and can exacerbate amnesia beyond that seen after more selective hippocampal lesions.Key words: amnesia; medial temporal lobe; human; explicit/ declarative memory; MRI; epilepsy surgery; H. M.At the 1953 meeting of the Harvey Cushing Society, Scoville (1954) discussed two patients (one epileptic, H. M., and the other schizophrenic) in whom he had performed "bilateral resection of the entire (pyriform-amygdaloid-hippocampal) complex including the hippocampal gyrus extending posteriorly for a length of 8 -9 cm from the tips of the temporal lobes." He reported that both patients experienced "a very grave, recent memory loss" (p 65). Independent of Scoville's report, Milner and Penfield (1955) documented a similar impairment in two patients after left temporal lobectomy. At autopsy, one of them had a substantial lesion in the right hippocampal formation (Penfield and Mathieson, 1974); the other was presumed (based on electroencephalography and the presence of automatism) (Feindel and Penfield, 1954;Penfield and Milner, 1958) to have a preoperatively unsuspected lesion in the right medial temporal lobe. Scoville realized his patients' importance for the understanding of human memory mechanisms, and when he learned of Penfield and Milner's findings, he invited them to examine his patients. The resulting paper (Scoville and Milner, 1957) described the findings for nine schizophrenic patients and H. M. Based on analyses ...